Pulmonology Coding Alert

Question: What is adult respiratory distress syndrome (ARDS)? How should we code it?

Alaska Subscriber

Answer: Adult respiratory distress syndrome (ARDS) is not a specific disease, rather a lung dysfunction associated with several diseases and medical conditions (i.e., pneumonia, shock, sepsis, drug overdose and trauma). Patients with ARDS exhibit symptoms that include breathlessness (786.05, Shortness of breath) and respiratory failure (518.81, Acute respiratory failure), pneumonia (486) or sepsis (038.9, Unspecified septicemia).

ARDS is associated with severe and diffuse injury to the alveolar-capillary membrane (the air sacs and small blood vessels) of the lungs. When under attack during an inciting event, some alveoli of the patient's lung accumulate fluids, while some collapse. This alveolar damage hinders the exchange of oxygen and carbon dioxide, which leads to a reduced concentration of oxygen in the blood. In turn, low levels of oxygen in the blood can cause damage to the patient's vital organs.

A pulmonologist will order several tests and procedures to diagnose ARDS. These include arterial blood gas (ABG) studies (36600, Arterial puncture, withdrawal of blood for diagnosis; 36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous), chest x-rays (71010-71035), and occasionally, pulmonary artery catheterization (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). During this phase, you shouldn't report 518.82 (Other pulmonary insufficiency not elsewhere classified) to show medical necessity for the tests and procedures. Instead, you would report the signs and symptoms the patient exhibits. Only when the physician is sure of the final ARDS diagnosis should you report 518.82.